Corporate slide master. Frank Atherton Chief Medical Officer October 2017

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1 Corporate slide master Prudent With guidelines Healthcare for corporate presentations in Wales Frank Atherton Chief Medical Officer October 2017

2 communication CITIZENS National Assembly for Wales Welsh Government Cabinet Secretary for Health, Wellbeing & Sport NHS Executive Board Health and Social Services Group (WG) Health Boards Welsh Ambulance Trust Permanent Secretary (WG) NHS Trusts Velindre NHS Trust Public Health Wales NHS Trust Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff & Vale Cwm Taf Hywel Dda Powys Local Communities/Stakeholders

3 Why think prudent? 3 million people in Wales 18 million primary care appointments / year 1 million OP referrals / year 400,000 emergency admissions / year 26 prescriptions / head / year 80 million blood tests (40% duplicates or ignored) Overall 10-30% contribution to health outcome

4 Evolution of Prudent Healthcare Autumn 2013 Bevan Commission paper January 2014 Minister s keynote address to Welsh NHS Confederation Conference Spring Applied workshops ENT, Orthopaedics, Pain and Prescribing January 2015 finalised principles July international prudent healthcare summit. National action plan idea floated. December 2015 Team Wales Event.

5 The guiding principles of prudent healthcare

6 Implicit paradigm shifts Specialist Complex Quantitative RCT Bench to Bedside Consultation Patient Diagnosis Effectiveness Medical Generalist Simple Qualitative Real world Home Service Person Symptom Experience Social

7 International Movement

8 Peer groups Education Innovation Finance Academy Finance Delivery Unit Atlas of Variation PROMS & PREMS ICHOM 1000 Lives Quality Improvement Value Based Care Prudent Healthcare Choosing Wisely Wales Quality and Value Initiatives in NHS Wales

9 Reallocating resource for Value across a programme of care (COPD) Inhaler Therapy Smoking & Flu PR HIGH low Inhaler Therapy Pulmonary Rehab Smoking & Flu Actual Spend Cost per Copyright Value Based Health Care Team; Aneurin Bevan University Health Board

10 PrescriberBasicPrice Respiratory Prescribing Cost Trend (WP10 & WP10HP) GP/ Nurse education events Asthma Adult Guidance Seretide evohaler to Flutiform started COPD pathway Mar-14 Jun-14 Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Period Courtesy of Jackie Reynolds

11 Reallocating resource for Value across a programme of care (COPD) : Finance Prescribing savings 1 million per annum Estimated 449k per annum saving through decreased healthcare utilisation (Griffith et al, Thorax 2001) Investment required for gold standard pulmonary rehabilitation service 241k per Copyright Value Based Health Care Team; Aneurin Bevan University Health Board

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13 Antibiotic prescribing by dentists in Wales Individualised prescription forms for dentists In 2015, only 1.8% dental prescriptions were unidentifiable Antimicrobial audit Newsletter for GDPs outlining audit findings Waiting Room poster for patients BDJ article VOLUME 221 NO. 1 JULY Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit

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15 Items of antibiotics Items of Antibiotics Prescribed , , , , , , , , , ,000 50,000 22% decrease between In 2015, 7% of all antibiotics prescribed in Primary care were dental Year Anup Karki, Consultant DPH, PHW : Antibiotic Prescribing in Primary Dental Care

16 Next Steps Strengthen national oversight/leadership Catalogue of successful initiatives Methodology for scaling National awards Integrate with Quality Improvement Incorporate into learning/development programs? public engagement

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